Surveillance of notifiable medical conditions (NMCs) is vital for a prompt, appropriate response. In South Africa, studies have demonstrated under-reporting of NMCs despite it being mandatory. Emergency departments (EDs) are often the first point of contact for patients with NMCs. This study aimed to assess ED clinicians' knowledge, attitudes, and practices regarding the reporting of conditions that are relevant to the ED, and the use of the new mobile application for reporting. A cross-sectional survey was conducted between November 2024 and April 2025, including 99 doctors at three public hospital EDs in Gauteng. The study assessed knowledge, attitudes and practices regarding NMCs and the use of the recently launched National Institute for Communicable Diseases (NICD) mobile application. The overall mean knowledge score was 61% (standard deviation [s.d.] 11.2). Knowledge accuracy of category 1 NMCs (mean 72%) exceeded that of category 2 NMCs (mean 56%; p < 0.001). Although 95% of respondents were aware that reporting NMCs is mandatory, 49% acknowledged under-reporting. Barriers to reporting included high workload, forgetfulness, and difficulty in locating the paper notification booklet. While 81% of respondents knew about the NICD mobile application, 68% had used it, and 17% had received formal training. Preference for the application versus the paper-based system was expressed by 78% of respondents. Under-reporting persists primarily because of high workload. A significant knowledge gap exists, particularly concerning category 2 NMCs. While the mobile application was preferred, a lack of formal training hinders its adoption. Staff training, feedback and reminders would improve the timely notification of these conditions. This study identifies under-reporting of NMCs and offers recommendations to strengthen the disease surveillance system and encourages the use of digital technology for reporting.
Echinococcosis most commonly presents as a slowly enlarging hepatic cyst, whereas extensive inflammatory extension with colonic involvement is uncommon. We report the case of an 80-year-old man who presented with abdominal pain and fever and reported having been aware of a hepatic echinococcal cyst for approximately 30 years. CT showed a giant calcified hepatic cyst containing an air-fluid level and intralesional gas, suggestive of secondary infection; intraoperative cyst-fluid culture subsequently grew Escherichia coli. Emergency laparotomy revealed dense inflammatory adherence to the transverse mesocolon and colon with obliteration of the dissection planes, necessitating right hemicolectomy with ileotransverse anastomosis, partial cyst wall excision, and drainage. Histopathology confirmed echinococcosis with extensive fibrosis, abscess formation, necrosis, and intestinal-surface involvement. The morphology raised suspicion for alveolar echinococcosis, although species-level confirmation was unavailable. The patient recovered uneventfully and received albendazole. This case highlights that chronically infected hepatic echinococcosis may mimic locally invasive disease and require adjacent-organ resection even without a demonstrable cystocolonic fistula.
Ileosigmoid knotting (ISK) is a rare, life-threatening form of closed-loop bowel obstruction predominantly reported in volvulus-endemic regions, characterized by rapid progression to gangrene and high mortality. This report details a severe case managed with a specialized two-stage approach. A 62-year-old man presented with a 36-hour history of severe crampy abdominal pain, bilious vomiting, and obstipation. Physical examination revealed a distended, tender abdomen, with vitals demonstrating shock. Laboratory results showed a left shift on the complete blood count. Abdominal X-ray suggested obstruction. Emergent exploratory damage control laparotomy revealed gangrene of the sigmoid colon and nearly the entire small bowel, sparing only 70 cm of the proximal jejunum and 10 cm of the distal ileum. Rapid resection without immediate restoration of continuity was completed within 30 minutes due to intraoperative shock. Temporary abdominal closure was achieved using a Bogota bag. Definitive care with jejunoileal end-to-end anastomosis and an end colostomy was completed in a second-look procedure 12 hours later, after adequate resuscitation. The patient was successfully transferred to an intensive care unit for specialized care. This case underscores the utility of damage control surgery in managing complicated compound volvulus with hemodynamic instability and massive necrosis. Early clinical awareness is essential to prevent extensive gangrene, reduce mortality, and optimize survival in resource-constrained settings.
Caudal epidural steroid injection (CESI) is a widely used minimally invasive procedure for the management of chronic low back pain and radicular symptoms and is generally considered safe. However, rare but serious infectious complications such as epidural abscess, cellulitis, and osteomyelitis may occur. We report a case of MRI-consistent sacrococcygeal osteomyelitis temporally associated with ultrasound-guided CESI in a 65-year-old female patient with a history of diabetes mellitus, hypertension, coronary artery disease, and prior L4-S1 posterior spinal stabilization surgery. The patient underwent CESI due to persistent low back and bilateral leg pain despite conservative treatment. Although she initially experienced significant symptomatic relief, she developed malaise and a burning sensation at the injection site on the third post-procedural day. Laboratory investigations revealed elevated acute-phase reactants, and the patient was subsequently hospitalized for further evaluation and management. Contrast-enhanced magnetic resonance imaging demonstrated findings were suggestive of sacrococcygeal osteomyelitis involving S4-S5 and Co1 levels, accompanied by surrounding soft tissue infection (cellulitis). Following infectious diseases consultation, empirical intravenous antibiotic therapy was initiated, resulting in marked clinical and laboratory improvement. This case highlights sacrococcygeal osteomyelitis as an exceptionally rare but serious complication of CESI and emphasizes the role of risk factors such as diabetes mellitus and prior spinal instrumentation surgery in the development of post-procedural infection, as well as the importance of early recognition of new or worsening pain after the procedure.
Hepatic hemangiomas are the most common benign mesenchymal tumors of the liver and usually demonstrate stable imaging characteristics over time, whereas spontaneous regression in adults remains uncommon and poorly documented in literature. We report the case of a 53-year-old woman with a giant hepatic hemangioma incidentally detected on magnetic resonance imaging (MRI) during evaluation of chronic nonspecific abdominal discomfort. Serial MRI examinations performed in February 2022, August 2023, and January 2025 demonstrated classic imaging findings of cavernous hemangioma, including marked T2 hyperintensity and peripheral nodular discontinuous enhancement with progressive centripetal fill-in, followed by substantial spontaneous regression without medical, surgical, or interventional treatment. Lesion dimensions changed from 14.1 × 9.4 × 9.5 cm to 15.9 × 10.0 × 9.5 cm, followed by regression to 8.0 × 5.4 × 4.7 cm, corresponding to an estimated volumetric reduction exceeding 80%. The patient remained clinically stable throughout follow-up, with no evidence of malignant transformation or clinically significant laboratory abnormalities. This case highlights that giant hepatic hemangiomas with characteristic MRI features may demonstrate substantial spontaneous regression during long-term follow-up and supports conservative management in clinically stable patients with typical imaging findings.
Venous malformations of the hand represent a clinical and therapeutic challenge due to anatomical complexity and functional and aesthetic impact. We report the case of a 13-year-old female patient with a venous malformation of the hand, treated with a combined approach using Nd:YAG 1064 nm transdermal laser and 1% polidocanol foam sclerotherapy. The combination of photocoagulation and sclerotherapy proved safe and effective in a superficial and localized lesion. This case underscores the relevance of combined therapy as a minimally invasive alternative for venous malformations of the hand, highlighting the importance of individualized treatment according to lesion location, depth, and extent.
Gait dysfunctions have been frequently observed in patients with Alzheimer's disease (AD). Previous studies have used various methods to assess the gait impairment in AD. Here, we developed a wearable gait sensor, a Smart-insole, which is embedded in shoe insoles. We evaluated whether gait parameters measured using the Smart-insole were associated with cognitive performance in patients with AD. Participants aged 45-90 years, who were either cognitively unimpaired (CU) or had Alzheimer's disease dementia (ADD) were recruited from a hospital-based outpatient clinic, between January and December 2023. Participants performed three gait tasks (walk straight and turn test, timed up and go test, and ramp and stair test) while wearing the Smart-insole. The association of gait parameters with individual's cognitive status (CU vs. ADD) and cognitive test scores (Mini-Mental State Examination [MMSE] and various domain-specific cognitive tests from the Seoul Neuropsychological Screening Battery, 2nd Edition) was assessed. Patients with ADD demonstrated decreased gait pace, rhythm, and stability as evidenced by longer task, cycle, and stance times, a higher number of steps, greater variability in swing time, and lower cadence during the gait task. Furthermore, gait parameters showed nominal associations with individual's MMSE score and each cognitive domain score (fronto-executive, memory, and language function). Smart-insole wearable sensors showed exploratory gait-related alterations in patients with ADD. These hypothesis-generating findings suggest that wearable insole-based gait assessment may provide complementary information for characterizing gait and cognitive dysfunction in ADD.
The 13th International Workshop on the CCN Family of Genes, held in Nice as part of the inaugural ARBIOCOM World Conference, brought together investigators with diverse research backgrounds, disciplines, and expertise. Building on the long-standing mission of the International CCN Society and the expanding ARBIOCOM initiative, the meeting highlighted the growing importance of interdisciplinary exchange in accelerating discovery in normal and pathological signaling networks. Scientific sessions featured presentations by renowned speakers and early-career investigators alike, creating a highly collaborative environment that fostered discussion of emerging concepts and translational opportunities. Among the major themes, this joint conference-meeting highlighted "hot" research topics such as the nuclear and extracellular roles of CCN proteins in regulating gene expression, tissue development and remodeling, stem cell differentiation and therapies, and disease initiation and progression. Presentations on skeletal biology emphasized how extracellular matrix proteins and matricellular factors shape bone, cartilage, and connective tissue development and pathology, whereas vascular sessions revealed new mechanistic links between extracellular cues, endothelial remodeling, macrophage-driven vessel regression and vascular smooth muscle homeostasis. Other talks extended the relevance of new signaling molecules in intestinal regeneration, hepatic inflammation, metabolic control, and cancer progression, illustrating the broad biological reach of these pathways. The meeting also emphasized the value of integrating new model systems, advanced single-cell approaches, and functional in vivo studies to uncover mechanisms that were previously unknown. Collectively, the scientific sessions and discussions identified and filled key knowledge gaps and generated new hypotheses with strong potential for future discoveries. By connecting established expertise with complementary scientific perspectives, this meeting provided a fertile platform for cross-pollination of ideas and highlighted several avenues for future research aimed at developing novel diagnostic and therapeutic strategies and tools.
High-sensitivity cardiac troponin T (hs-cTnT) is widely used as a gold-standard marker of myocardial injury, yet non-ischemic elevations can occur in idiopathic inflammatory myopathies (IIM), creating a significant diagnostic pitfall. In contrast, high-sensitivity cardiac troponin I (hs-cTnI) generally retains strict cardiac specificity. A 79-year-old female presented with progressive fatigue and elevated cardiac enzymes. Admission hs-cTnT was markedly elevated at 521 ng/L (reference 0-14 ng/L), and she was initially suspected of having a non-ST elevation myocardial infarction (NSTEMI) and underwent emergency coronary angiography, which revealed non-obstructive coronary artery disease. Polyethylene glycol (PEG) precipitation demonstrated a recovery rate exceeding 80%, excluding macromolecular complex interference, while follow-up hs-cTnT testing at an external hospital confirmed the elevation. However, hs-cTnI measured on both the Abbott and Yhlo platforms remained within normal limits. This hs-cTnT(+)/hs-cTnI(-) discrepancy, combined with electromyography (myogenic damage), muscle MRI, and a normal echocardiogram, established the final diagnosis of polymyositis (PM). Regenerating skeletal muscle fibers can re-express embryonic cTnT isoforms, producing a true circulating cTnT elevation of skeletal muscle origin that mimics myocardial injury. PEG precipitation confirmed authentic monomeric cTnT antigen rather than an analytical artifact, redirecting the diagnostic focus. Concurrent hs-cTnI assessment is a critical strategy for distinguishing skeletal muscle-derived cTnT from true myocardial injury, thereby preventing misdiagnosis and unnecessary interventions in patients with inflammatory myopathies.
A 69-year-old male patient developed a painless, gradually increasing mass in the upper part of his right thigh, with no pulmonary symptoms. Magnetic resonance imaging revealed a nodular lesion in the lateral femoral muscle, which was initially suspected to be a primary soft tissue tumour. After the mass was surgically removed, the histopathological examination confirmed squamous cell carcinoma (SCC), and the immunohistochemical staining of P63 and CK5/6 was positive. Subsequent FDG PET/CT examination revealed a hypermetabolic nodule in the upper lobe of the right lung. Endobronchial ultrasound-guided biopsy confirmed it as primary lung SCC. This case indicates that isolated skeletal muscle metastasis can be the initial manifestation of occult lung cancer. The research results suggest that seemingly isolated soft tissue masses may be the first sign of latent malignant tumours.
[This corrects the article DOI: 10.7759/cureus.113636.].
Spinal and bulbar muscular atrophy and Parkinson's disease rarely coexist. We describe a male patient presenting with parkinsonism, hyposmia, with DAT-SPECT deficits, responsive to dopaminergic therapy, preceding recognition of SBMA confirmed genetically. Dopamine agonist-associated dropped head syndrome unmasked underlying lower motor neuronopathy, highlighting diagnostic pitfalls and overlap between synucleinopathy and polyglutamine disease.
Intramuscular fat grafting has emerged as a transformative technique in aesthetic surgery, particularly within modern body contouring procedures where high-definition contouring and selective volume enhancement are desired. While subcutaneous fat grafting remains a foundational approach, intramuscular injection has been suggested to provide superior definition, projection, and dynamic contouring in selected anatomical regions. Nevertheless, its clinical adoption remains controversial due to ongoing concerns regarding safety, variable fat retention, and inconsistent reporting of complications. A structured literature search was conducted in PubMed, ScienceDirect, and the Cochrane Library using database-specific combinations of intramuscular- and fat grafting-related terms, yielding 495 reports. Ultimately, 45 studies met the inclusion criteria and were retrieved. Analysis focused on safety, fat retention, and clinical outcomes. The included studies suggested favorable aesthetic outcomes and generally positive reported satisfaction across selected facial, truncal, and extremity applications, although outcome reporting was heterogeneous and often non-standardized. While animal models present conflicting retention data, clinical series have described acceptable volume persistence in selected settings. Safety appeared to be strongly region-dependent. While intramuscular gluteal injection remains associated with a prohibitive embolic risk, non-gluteal ultrasound-guided applications reported low rates of major complications in the reviewed literature, although the available evidence remains limited. In conclusion, this review summarizes reported intramuscular fat grafting techniques and synthesizes the available evidence on outcomes and region-specific safety considerations. Future studies must focus on comparing this approach to subcutaneous grafting in larger cohorts.
The BODY-Q is a validated patient-reported outcome measure for assessing perceptions of appearance, health-related quality of life and healthcare experiences. Perception of appearance and body image are influenced by cultural, demographic and societal factors that vary across populations. This study aimed to generate Australian normative BODY-Q data. Secondary aims were to understand variation across sociodemographic groups and between geographic regions. Participants aged 18 years and older and currently living in Australia provided sociodemographic information and completed appearance and health-related quality of life domains of the BODY-Q. Scale scores were compared across socio-demographic groups, and means compared to published North American and European normative data. Data were collected from 805 Australian participants. Women reported lower scores than men in four of the five appearance scales and five of the six health-related quality of life scales. Presence of chronic health condition(s) was associated with lower scores in four of the five appearance scales and five of the six health-related quality of life scales. Higher body mass index was associated with lower scores in all BODY-Q scales. Younger age was associated with worse Appearance-related Psychosocial Distress but minimal difference in other scales. Australian participants showed similar scores to Europeans, and both were higher than in North America. This study provides the first Australian normative scores for the BODY-Q and represents the second publication of normative BODY-Q data internationally. The findings highlight the importance of region-specific normative scores and collecting relevant socio-demographics in patient-reported outcome measures research.
Tuberculosis (TB) remains a major global health challenge, particularly in low-income settings where structural inequities hinder early diagnosis and care. Ethiopia, one of the 30 high TB-burden countries, continues to experience marked geographic disparities. Understanding knowledge, attitudes, and practices (KAP) among affected populations is essential to inform context-specific interventions supporting the End TB Strategy. A cross-sectional KAP survey was conducted in Woliso District (Oromia Region, Ethiopia) between April 2023 and December 2024, including 152 TB index cases and 326 household contacts. A structured, interviewer-administered questionnaire assessed knowledge of TB symptoms, transmission, diagnosis, and perceived barriers to care. Categorical variables were compared using Chi-square or Fisher's exact test, and continuous variables with Mann-Whitney test. Among 478 participants (median age 28 years [IQR 19-40]; 44.1% female), 69.5% lived in rural areas. The main barriers to timely diagnosis were absence of nearby TB diagnostic facilities (13.4%), poor road conditions (6.3%), health system delays (5.9%), and financial constraints for transportation (3.8%). Poor roads and transport costs were reported more often by rural residents (p < 0.05), while absence of nearby TB diagnostic facilities was reported most often by index cases and older subjects (p < 0.05). Recognition of cough lasting >2 weeks (84.3%) and night sweats (65.7%) was common, while hemoptysis (49.6%) and fever (16.1%) were less recognized. Awareness of sputum and X-ray diagnostics was 87.2%, higher among index cases (95.4% vs. 83.4%, p = 0.0005). Although 77.0% considered TB life-threatening, 52.2% believed it was transmissible only through close or bed-sharing contact (p < 0.0001 for rural vs. urban). Older age correlated with better knowledge across most domains (all p < 0.01). Overall, subjects living in rural area had higher scores about barriers for accessing TB care (p = 0.0004) and attitude on TB (p = 0.01), and lower score about knowledge on TB (p = 0.002). While TB knowledge and attitudes were generally high, misconceptions about transmission and persistent structural barriers hinder access to timely diagnosis and care. Expanding community-based diagnostic capacity, improving rural infrastructure, and integrating social protection strategies are key to advancing Ethiopia's progress toward End TB targets.
The application of silicone sheets to surgical wounds is currently recommended for hypertrophic scar and keloid prophylaxis after closure of surgical incisions. The use of other types of tapes that differ in cost and biomechanical properties has been reported, although a formal synthesis on this topic within recent years has yet to be undertaken. MEDLINE, Embase and Cochrane were comprehensively searched between January 2000 - December 2025, following the PRISMA guidelines. Included studies evaluated cosmetic outcomes of adult patients (≥18 years) undergoing surgical wound taping following primary wound closure. Randomised controlled trials, comparative cohort studies, and case series (n≥5) were eligible. In the 14 included studies, microporous tapes and Steri-Strips were most popular, encompassing 217 and 159 patients respectively. Cosmetic outcomes were assessed at a mean of 5.13 months (range 21 days to 12 months), using heterogeneous tools including SCAR-Q, Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale, and Visual Analogue Scales. The application of tapes after primary closure showed significant improvements in scar cosmesis compared to patients without any interventions (n=75), with some evidence suggesting that more inexpensive paper tapes produce clinically similar results to gold-standard silicone sheets. Surgical wound taping using adhesives other than silicone sheets appears to be an effective strategy for improving scar cosmesis. Further randomised controlled trials studies using a consistently layered primary closure methods and directly comparing different types of tapes including silicone sheets using longer follow up and standardised reporting outcomes are needed.
Chirality critically governs the pharmacodynamics and clinical performance of small molecule drugs, yet its role in governing bio-nano interactions of synthetic polymeric nanocarriers has remained largely unexplored. Surface grafting with hydrophilic, biocompatible "stealth" polymers such as poly(ethylene glycol) (PEG) is a critical design strategy for nanomedicines intended to reduce nonspecific biological interactions and achieve prolonged circulation. However, the rising prevalence of anti-PEG antibodies has driven the search for fundamentally new design principles, mostly focused on substituting PEG with an entirely different polymer type. Poly(2-oxazoline)s (POx) constitute a versatile class of biocompatible synthetic polymers that uniquely enable access to numerous water-soluble macromolecules that can be rendered chiral, an attribute rarely accessible in synthetic stealth polymers. Here, we report the fabrication of crystalline-core nanorods bearing a chiral poly(2,4-dimethyl-2-oxazoline) (PdMeOx) corona via crystallisation-driven self-assembly (CDSA), and examine the influence of polymer chirality on biodistribution and antibody recognition in vivo. Well-defined enantiopure and racemic PdMeOx-b-poly(2-(isopropyl)-2-oxazoline) block copolymers were synthesised and assembled into short nanorods with distinct optical activities, enabling a detailed investigation of chirality-dependent bio-nano interactions. We demonstrate that polymer chirality induces the generation of enantiomer-specific antibodies, an effect that has not previously been reported for synthetic macromolecular nanomaterials. These findings reveal stereochemistry as an orthogonal design parameter for modulating immune interactions and suggest a future strategy in which alternating polymer chirality, rather than changing polymer type, can be exploited to mitigate antibody-mediated clearance through structured dosing regimens.
Ureteral entrapment within the sacroiliac joint is an exceedingly rare anatomical phenomenon. To date, 6 cases have been documented in the literature: 1 cadaveric and 5 clinical reports. Among the clinical cases, 3 followed high-energy pelvic trauma, while 2 were nontraumatic. We report the third nontraumatic clinical case (and seventh case overall) in a 77-year-old woman presenting with chronic lower back pain. Computed tomography intravenous pyelography revealed focal entrapment of the right ureter at the level of the sacroiliac joint due to advanced degenerative sacroiliitis. Despite a 10-12 hours delay in contrast excretion, the patient was urologically asymptomatic with stable renal function. Unlike previous nontraumatic cases requiring surgical intervention or nephrostomy, this patient was managed conservatively.
Total parotidectomy (TP) has been advocated to ensure complete tumor clearance and removal of intraparotid lymph nodes; however, less-than-total parotidectomy (LTT) may offer comparable oncologic control with superior functional outcomes. In this systematic review and meta-analysis, we compared oncologic and functional outcomes between LTT and TP for patients with T1-2 low-grade parotid malignancies. A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four retrospective cohort studies of T1-2 low-grade parotid cancer were included. Patients underwent either LTT or TP. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Pooled hazard ratios with 95% confidence intervals were calculated using random-effects models. Heterogeneity was assessed using I 2 statistics and the Cochran's Q test. The pooled analysis demonstrated no significant difference in OS between LTT and TP based on three studies. Across the four studies, RFS was comparable between the two surgical approaches, and statistical heterogeneity was negligible for both OS and RFS. No evidence of publication bias was detected. In selected patients with T1-2 low-grade parotid malignancies confined to the superficial lobe, LTT showed no statistically significant disadvantage in OS or RFS compared with TP based on the available retrospective evidence. However, the high risk of bias across included studies limits causal interprettion. Surgical strategy should therefore be individualized and should prioritize negative margins and functional preservation when oncologically appropriate. Prospective studies with standardized oncologic and functional outcome reporting are warranted. 3.
Infertility can cause significant distress to women, increasing the risk of anxiety and depression. This systematic review examined the influence of self-compassion interventions on mental health and well-being among women experiencing infertility. The review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported following PRISMA guideline. Databases searched included Medline, Embase, Ovid nursing database, Emcare, PsycINFO and Cochrane Library from inception to November 2024. Quality assessment was conducted using JBI critical appraisal tools. Title and abstract screening was conducted by three reviewers, and data extraction was performed independently by two reviewers. Sixteen studies met the inclusion criteria, seven intervention studies (n = 591 participants) and nine cross-sectional studies (n = 3005 participants). Intervention studies reported a reduction in depression, anxiety, shame and feelings of defeat, alongside improvements in self-compassion, well-being, quality of life (QoL), self-efficacy, emotion regulation difficulties and coping strategies. Meta-analysis was not undertaken due to substantial clinical, methodological and outcome heterogeneity across included studies. Cross-sectional studies indicated that higher self-compassion was associated with lower fertility-related stress and better psychological outcomes. Overall, the findings suggest that self-compassion interventions, including education-based approaches, may improve psychological health and resilience in women experiencing infertility. Incorporating multi-faceted education-based strategies to enhance self-compassion may provide further support and resilience for this population.